AF Form 3951 INTERCONTINENTAL BALLISTIC MISSILE HARDENED INTERSITE CA

INTERCONTINENTAL BALLISTIC MISSILE HARDENED INTERSITE CABLE
RIGHT-OF-WAY LANDOWNER/TENANT QUESTIONNAIRE

OMB NO. 0701-0141
Expires:

The Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments
regarding this burden estimate or any other aspect of the this collection of information, including suggestions for reducing the burden, to Department of
Defense, Washington Headquarters Services, Director of Information Operations and Reports (0701-0141), 1215 Jefferson Davis Highway, Suite 1204,
Arlington VA 22202-4302; and to OMB, Paperwork Reduction Project, Washington DC 20503. Respondents should be aware that notwithstanding any
other provisions of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid
OMB control number. Please DO NOT RETURN your form to either of these addresses. Please complete questionnaire on reverse of this form and
return in pre-addressed, postage paid envelope provided. If pre-addressed envelope is not used, please send your completed form to the local missile
complex maintenance unit's office.

PRIVACY ACT STATEMENT
AUTHORITY: 10 U.S.C. 9013, Secretary of the Air Force; powers and duties; delegation by.
PURPOSE: Used to track, monitor, and coordinate activities (i.e., highway crossing, utility crossing, construction, earth moving, etc.)
affecting the Hardened Intersite Cable System (HICS) and/or its right-of-ways (ROWS) and could impair HICS hardness integrity.
ROUTINE USES: No disclosures will be made outside of DoD.
DISCLOSURE: Furnishing information is voluntary. Failure to provide the information would greatly impair the ability of the U.S. Air Force
to schedule and coordinate missile cable maintenance efforts with affected landowners/tenants.
SYSTEM OF RECORDS NOTICE: F021 AFGSC A Cable Affairs Personnel/Agency Records
1. LANDOWNER/TENANT INFORMATION:

AF FORM 3951, XXXXXXX (IMT-V1)

PREVIOUS EDITIONS ARE OBSOLETE.

2. IS LANDOWNER/TENANT INFORMATION SHOWN ON FRONT OF THIS FORM CORRECT/COMPLETE?

YES

NO

IF NO, PLEASE CORRECT OR INCLUDE THE INFORMATION. IF YOU ARE THE LANDOWNER AND THE TENANT INFORMATION ON THIS FORM IS INCORRECT,
PLEASE PROVIDE CURRENT TENANT INFORMATION; INCLUDE CURRENT TENANT'S NAME, ADDRESS, AND TELEPHONE NUMBER.

3. DO YOU HAVE OR KNOW OF ANY OF THE FOLLOWING CONDITIONS CONCERNING THE MISSILE CABLE ROUTE ON YOUR PROPERTY? IF YES, PLEASE
PROVIDE THE LOCATION IN THE SPACE PROVIDED.
a. DEVELOPING EROSION ALONG THE MISSILE CABLE ROUTE AND/OR EXPOSED MISSILE CABLE.

YES

NO

b. MISSILE CABLE FENCE/ACCESS GATES DAMAGED AND/OR REQUIRING REPAIR.

YES

NO

c. MISSILE CABLE ROUTE MARKER POSTS DAMAGED, LEANING, OR DOWN.

YES

NO

YES

NO

4. DO YOU HAVE ANY PROJECTS OR ACTIONS (such as construction or excavations) PLANNED FOR AREAS ON OR NEAR THE
MISSILE CABLE ROUTE?
IF YES, PLEASE PROVIDE SOME GENERAL INFORMATION AND LOCATION OF YOUR PLANNED PROJECT/ACTION.

THANK YOU FOR YOUR TIME AND EFFORTS IN COMPLETING THIS FORM.

AF FORM 3951, XXXXXXX (REVERSE) (IMT-V1)